Difficult to Diagnose: An Unusual Cause of Cavitary Lung Lesion

Patient: Male, 40-year-old Final Diagnosis: Histoplasmosis Symptoms: Dyspnea Medication:— Clinical Procedure: Bronchoscopy Specialty: Pulmonology OBJECTIVE: Unknown ethiology BACKGROUND: Cavitary lung lesions are commonly identified on thoracic imaging, but typically require further workup for definitive diagnosis. CASE REPORT: Here, we present the case of a 40-year-old Middle Eastern male who presented with an unusual cause of cavitary lung lesion with associated pleural mass and pleural thickening. He underwent bronchoscopic biopsy and computer tomography (CT)-guided core needle biopsy, both of which were non-diagnostic. Surgical biopsy subsequently revealed hyalinized necrotizing granulomatous tissue, consistent with histoplasmosis, and the patient was treated with itraconazole, which he responded well to. CONCLUSIONS: This case demonstrates the importance of identifying unusual causes of cavitary lung lesions and emphasizes the role of using proper tissue sampling for diagnosis.